Background Contemporary data relating to antipsychotic prescribing in UK primary care for patients diagnosed with severe mental illness (SMI) are lacking.Aims To describe contemporary patterns of antipsychotic prescribing in UK primary care for patients diagnosed with SMI.Method Cohort study of patients with an SMI diagnosis (i.e. schizophrenia, bipolar disorder, other non-organic psychoses) first

Background Studies in cognitively normal individuals on associations between psychiatric symptomatology and incident dementia have not reliably differentiated psychiatric syndromes from neuropsychiatric symptoms (NPS) that represent neurodegeneration. Conventional modelling often overlooks symptom natural history. Mild behavioural impairment (MBI) is a syndrome that leverages later-life emergent and

Stendhal syndrome represents a compelling psychosomatic response, characterised by intense emotional and physiological reactions to viewing art, that intersects the fields of psychiatry, neurology and aesthetics. Despite lacking formal diagnostic recognition, a confluence of historical anecdotes and contemporary research underscores its validity as a unique neuropsychiatric phenomenon. This review

Background Anorexia nervosa is a psychiatric disorder characterised by undernutrition, significantly low body weight and large, although possibly transient, reductions in brain structure. Advanced brain ageing tracks accelerated age-related changes in brain morphology that have been linked to psychopathology and adverse clinical outcomes.Aim The aim of the current case–control study was to characterise

Regarding the article, ‘Efficacy and safety of a 4-week course of repeated subcutaneous ketamine injections for treatment-resistant depression (KADS study): randomised double-blind active-controlled trial’, we commend Loo et al1 for undertaking the Ketamine for Adult Depression Study (KADS). In the interest of ensuring that accurate and balanced information is presented to healthcare professionals

Background The prenatal and early-life periods pose a crucial neurodevelopmental window whereby disruptions to the intestinal microbiota and the developing brain may have adverse impacts. As antibiotics affect the human intestinal microbiome, it follows that early-life antibiotic exposure may be associated with later-life psychiatric or neurocognitive outcomes.Aims To explore the association between

Background Links between personality disorders and antisocial outcomes has not examined individual personality disorders, and the contribution of comorbidities remain uncertain. Previous systematic reviews are dated.Aims To synthesise evidence from observational studies on the risk of antisocial outcomes and recidivism associated with personality disorders.Method We searched six bibliographic databases

Background Clozapine therapy presents a risk of agranulocytosis, necessitating monitoring of white blood cell count. The detection of benign ethnic neutropenia (BEN), in which neutropenia can be present without an increased risk of infection, is particularly important in preventing unnecessary withdrawal of clozapine. BEN is strongly linked to the CC homozygote of the single nucleotide polymorphism

An overview of changes in the classification of personality disorders from ICD-10 to ICD-11 is presented. The new classification incorporates a dimensional approach centred on severity with five domains available to describe personality pathology. The potential clinical utility of the new approach is discussed.

Background Using [18F]altanserin, a serotonin 2A receptor (5-HT2AR) antagonist Positron Emission Tomography (PET) tracer, a positive association between cortical 5-HT2AR binding and the inward-directed facets of neuroticism has been demonstrated in healthy individuals. Psilocybin, a 5-HT2AR agonist, shows promise for the treatment of depression, reducing neuroticism and mood symptoms potentially via

Background Antidepressants’ effects are established in randomised controlled trials (RCTs), but not in the real world.Aims To investigate real-world comparative effects of antidepressants for depression and compare them with RCTs.Method We performed a cohort study based on the QResearch database. We included people with a newly recorded diagnosis of depression, exposed to licensed antidepressants in

Background Discipline is a crucial aspect of parenting, shaping child development and behaviour. Time-out, a widely used disciplinary strategy with a strong evidence-base, has recently come under scrutiny with concerns about potential adverse effects on children's emotional development and attachment, particularly for those with a history of adversity.Aims To contribute critical empirical insights

Background Evidence is largely limited regarding the extent to which abnormal behavioural profiles, including physical inactivity, sedentary behaviour and inadequate sleep duration, impact long-term health conditions in individuals with pre-existing depression.Aims To investigate the associations between accelerometer-derived daily movement behaviours and mortality in individuals with pre-existing

This editorial highlights increasing prevalence and treatment rates of apparently disparate disorders. We ask whether cross-disorder factors including greater mental health literacy, social media and a shift to psychiatric explanations for distress contribute to these trends. We highlight a consequence: the changing doctor–patient relationship and its impacts.

Psychotic disorders have sex-specific differences in their onset, symptoms and course. The early intervention in psychosis model represented the first step toward personalised psychosis care, recognising stage-specific care needs. Incorporating knowledge about sex-specific differences in care programmes should be the next evolution of personalised psychosis care.

In November 2023, the Department of Health and Social Care published guidance, entitled ‘Baroness Hollins’ Final Report: My Heart Breaks – Solitary Confinement in Hospital Has no Therapeutic Benefit for People with a Learning Disability and Autistic People’. The report's commendable analysis of the problems and identification of the areas where practice should be improved is unfortunately not matched

Background The clinical high risk for psychosis (CHR-p) syndrome enables early identification of individuals at risk of schizophrenia and related disorders. We differentiate between the stigma associated with the at-risk identification itself (‘labelling-related’ stigma) versus stigma attributed to experiencing mental health symptoms (‘symptom-related’ stigma) and examine their relationships with key

Background Abrupt cessation of heavy cannabis use can cause a withdrawal syndrome characterised by irritability, anxiety, insomnia, reduced appetite and restlessness. Recent reports have also described people in whom cannabis withdrawal immediately preceded the acute onset of psychosis.Aims To identify cases of psychosis associated with cannabis withdrawal.Method We completed a systematic review of

Background In patients with treatment resistant depression (TRD), the ESCAPE-TRD study showed esketamine nasal spray was superior to quetiapine extended release.Aims To determine the robustness of the ESCAPE-TRD results and confirm the superiority of esketamine nasal spray over quetiapine extended release.Method ESCAPE-TRD was a randomised, open-label, rater-blinded, active-controlled phase IIIb trial

‘Each has shaped the other.’1 Evidence abounds on the salience of attachment to early development and beyond. In 2018, Adshead distilled the relevance of 20 years of attachment theory to psychiatric practice.2 We argue research funders must move one step further: develop the evidence around perinatal attachment-informed interventions.

In the context of climate change, the impacts of extreme weather events are increasingly recognised as a significant threat to mental health in the UK. As clinicians and researchers with an interest in mental health, we have a collective responsibility to help understand and mitigate these impacts. To achieve this, however, it is vital to have an appreciation of the relevant policy and regulatory frameworks

Background Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.Aims To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.Method We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service

Background Minoritised young people face a double burden of discrimination through increased risk of stress and differential treatment access. However, acute care pathways for minoritised young people with urgent mental health needs are poorly understood.Aims To explore variation in stress-related presentations (SRPs) to acute hospitals across racial-ethnic groups in England.Method We examined rates

Background Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear.Aims To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions.Method This study undertook the first analyses

Immigration policies designed to deter people from seeking asylum are gaining traction in many Western nations, with the UK recently attempting to establish an offshore immigration processing centre in Rwanda. This letter outlines emerging evidence from Australia on the negative long-term psychological effects of offshore processing on people seeking asylum.

Background An important contributor to the decreased life expectancy of individuals with schizophrenia is sudden cardiac death. Arrhythmic disorders may play an important role herein, but the nature of the relationship between schizophrenia and arrhythmia is unclear.Aims To assess shared genetic liability and potential causal effects between schizophrenia and arrhythmic disorders and electrocardiogram

Background Personalised management of recurrent depression, considering individual patient characteristics, is crucial.Aims This study evaluates the potentially different mediating role of mindfulness skills in managing recurrent depression using mindfulness-based cognitive therapy (MBCT) among people with varying depression severity.Method Data from the Prevention of Depressive Relapse or Recurrence

Antipsychotic medications targeting dopamine receptors were identified 70 years ago. Recent clinical trials have shown that agonists of muscarinic acetylcholinergic receptors can improve both psychotic and negative symptoms in schizophrenia. Here, this new approach to the treatment of schizophrenia is reviewed in anticipation of the drugs being licensed clinically.

Background Attempts to use artificial intelligence (AI) in psychiatric disorders show moderate success, highlighting the potential of incorporating information from clinical assessments to improve the models. This study focuses on using large language models (LLMs) to detect suicide risk from medical text in psychiatric care.Aims To extract information about suicidality status from the admission notes

Background Breast cancer is a major global health issue, especially among women. Previous research has indicated a possible association between psychiatric conditions, particularly schizophrenia, and an increased risk of breast cancer. However, the specific risk of breast cancer in women with schizophrenia, compared with those with other psychiatric disorders and the general population, remains controversial

Background Positive, negative and disorganised psychotic symptom dimensions are associated with clinical and developmental variables, but differing definitions complicate interpretation. Additionally, some variables have had little investigation.Aims To investigate associations of psychotic symptom dimensions with clinical and developmental variables, and familial aggregation of symptom dimensions

Evidence indicates that ketamine is highly effective, has a lower side effect profile and is better tolerated compared to many augmentation strategies for refractory depression. This, combined with data on psychiatric treatment outcome mediators, suggests that earlier intervention with ketamine could improve outcomes for patients suffering from refractory depression.

An important change in ICD-11 is the lifespan approach, whereby previous child and adolescent disorders have been amalgamated with adult disorders. There have been changes in the definition/descriptions of neurodevelopmental and disruptive disorders, some of which may have an impact on service development.

Background Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD)Aims To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities.Method Building on the current Cochrane review of medications in BPD, an update literature search

This guest editorial describes the importance of converging genetics and psychosocial epidemiology research methods to understand the biopsychosocial etiology of psychiatric phenotypes.